1 Introduction
Menstrual pain is a commonly experienced pain among women, people who menstruate, and non-menstruating people
1. While lower abdominal cramping is the most well-known symptom of menstrual pain, in this paper we use the term menstrual pain to include a wider spectrum. This is inclusive of dysmenorrhea (both primary and secondary dysmenorrhea), and pain-related symptoms of endometriosis, through to lower back pain, leg pain, nausea, vomiting, diarrhoea, fatigue, fever, headache, and lightheadedness [
20] as well as psychological symptoms such as premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD).
Menstrual pain is commonly treated with pharmaceuticals such as nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal contraceptives, and paracetamol [
51]. With the growing interest in FemTech ("Female Technologies") industry in recent years, many commercial non-pharmaceutical products have entered the market explicitly targeting menstrual pain. These products are marketed as lifestyle products and often utilise technologies such as Transcutaneous Electrical Nerve Stimulation (TENS)
2, electric heat, mechanical massage features or app-based habit/pain tracking functions [
51,
112]. Despite the emergence of commercial FemTech products for menstrual pain management, menstrual pain is an area yet to be explored in detail within the HCI field [
18,
102]. Yet, designing for menstrual pain affords an intriguing opportunity to explore long-term and adaptable modes of technological care, since it is experienced differently across the life span, in each menstrual cycle, and in varying embodiments [
22]. Menstrual pain is also a highly subjective and uneasy experience. Designing for and with this type of experience could probe diverse ways in which humans relate to, and interact with technologies during the moments that are not inherently positive [
23]. It is to this research gap that our work seeks to contribute. We achieve this through critical reflections on existing commercial products for menstrual pain, from which we develop designerly knowledge for creating pain-centric care technologies.
In order to understand the kinds of assumptions, narratives and bodies made by existing commercial products, we draw on feminist disability studies (FDS). Menstrual pain is a complex experience that cannot be solely explained by biomedical terms. It is deeply entangled with sociocultural constructs around pain and long histories of menstrual stigma [
83]. The normative conceptions of health, femininity, pain, menstruation, and menstrual pain (as a feminised chronic type of pain) are projected in and in turn, shaped by commercial products for menstrual pain. Thus, analysing these products calls for a feminist crip theoretical framework so as to shed light on such complex embodiment interlocking gender and disability, while recognising the lived realness of menstrual pain. Feminist disability studies is a critical scholarship that explores how gendered perspectives and power dynamics intersect with disability experiences and contribute to certain forms of oppression [
40]. In drawing from FDS, we do not intend to equate menstrual pain with disability nor shoehorn the critical discourse around disability into the experience of menstrual pain. As Julie Avril Minich and Sami Shalk contend [
69,
94], we use FDS as a theoretical framework “that proceeds
not from narrowly-defined notions of what “counts” as a disability
but one that seeks to radically disrupt the multiple sociopolitical ideologies that assign more value to some bodies and minds than to others” [
69]. In other words, we draw on ideas from FDS on pain, disability, and bodily disruptions to disentangle the assumptions and narratives of menstrual pain and its embodiments embedded in the products and technologies.
In this paper, we apply feminist disability studies’ (FDS) theoretical perspectives on disability and pain to re-imagine what menstrual pain technologies might look like if they were designed for menstrual pain as a chronic, cyclical, lived experience. We seek to answer the following research questions: (1) what kinds of assumptions and narratives of menstrual pain are current commercial menstrual pain technologies based on? (2) how are these technologies, in turn, likely to shape a user’s body in relation to menstrual pain? (3) and what kinds of feminist design spaces for menstrual pain can be opened by the means of an alternative theoretical framing of the body in pain? By doing so, we contribute to the field conceptual design knowledge for the development of menstrual pain-centric technologies. We undertook an interaction critique to analyse the material and aesthetic qualities of existing commercial menstrual pain technologies; the kinds of bodies these technologies construct; and the types of relations to pain these technologies buttress. Our interaction critique surfaced a generally skewed conception of menstrual pain – a diagnosed, pathological and individual condition of impairment that is to be cured. Based on this analysis, we offer three design provocations centring the feminist crip conception of menstrual pain and self-care. These provocations open up a new design space for menstrual pain care technologies by hinting at experiential qualities that foreground (1) the lived experience of menstrual pain; (2) chronic yet cyclical menstrual pain time; (3) and pain’s potential for leaky coalitions. We anticipate that this design-oriented knowledge will be helpful for makers, practitioners, and researchers designing care technologies for menstrual pain. And we foresee that some of this knowledge can be transferable to designing with/for other chronic pain contexts.
2 Menstruation and Menstrual Pain in HCI and Design
In recent years, menstruation has received growing attention within the fields of HCI and design. A body of research has critiqued how menstrual technologies are designed and has proposed alternative approaches. Notably, many scholars have critiqued menstrual and fertility tracking technologies for upholding gendered and normative stereotypes [
26,
32,
86,
87]. Some of the works have highlighted these technologies’ orientation towards (re)productivity, instrumentalising the menstruating body to conform to ideals, and fit into the capitalist labour force [
15,
26,
30,
31]. Countering this, researchers have troubled these norms through critical and speculative design [
31,
86,
109]. Other bodies of work have focused on how FemTech often perpetuates negative social stigmas of dirt and disgust around menstruating bodies and menstrual blood, reinforcing menstrual concealment [
16,
110]. These works offered alternative approaches for HCI and design through fostering deeper engagement with the materiality of menstruating bodies. The privacy risks of commercial FemTech products and commercialisation of intimate menstrual/fertility data have been also heavily pointed out [
2,
31,
67,
85]. These aspects have gained even more urgency accompanied with regressive local legislative changes like the overturning of Roe v. Wade in the USA [
64,
105].
Research subscribing to feminist HCI [
9] has aimed to make menstruation more visible by studying the labour and infrastructures that enable or challenge menstrual management in public spaces and “on the go” [
33,
114]. These works highlight the importance of designs that resist menstrual concealment while still ensuring access to safe and private spaces. Tuli et al. [
114] argued for shifting the focus from the individual to community-driven practices and stressed coalitional efforts to support each other as menstruators and non-menstruators alike.
A number of feminist HCI design projects have actively worked to challenge existing norms by introducing period-positive worldviews. These works have acknowledged the lived experience of menstrual cycles as important and valuable sources of bodily knowledge, entangled with all aspects of life (e.g., [
13,
104,
115]). Søndergaard et al. [
104], for instance, drew from their own menstrual experiences to design an open-ended prototyping kit of shape-changing objects that can be worn or used in close contact with intimate areas of the body, encouraging exploration and attunement to the first menstrual experiences (menarche). Notably, in a later study [
103], where the researchers conducted workshops with adolescents using the kit, participants designed for addressing menstrual pain. Participants described how wearing shape-changing modules on their abdomen might help with encouraging movement, which they felt was restricted while menstruating – not only by the physical pain, but also due to shame and a need to conceal their experiences [
103]. Similarly, participants in Ciolfi Felice et al.’s [
19] design workshop engaged with design as a way of resisting the medicalisation of their –at times painful– experiences of menopause. These body-centred approaches all yielded prototypes that made space, both literally and metaphorically, by creating publicly visible, tangible or wearable objects that took up not only physical space but also made a statement.
Meanwhile, several works in the context of menstruation have turned to the sense of touch and tactility in particular, as a means of creating bodily knowledge and further countering menstrual stigma (see, e.g., [
5,
14,
16]). In line with feminist scholars such as Barad [
6] and Puig de la Bellacasa [
84], Campo Woytuk et al. [
16] have called for engaging with touch when designing for menstrual care. They argued that touching intimate bodily materials, such as menstrual blood or cervical mucus, allows people to both learn about their menstrual cycles and bodily functions, as well as working towards destigmatising these fluids and reframing them as valuable. In [
16], the authors reported on their participants touching themselves in menstrual pain with a small heat pad, both to relieve the pain and to explore their intimate bodies.
Considering the extent of HCI and design research on menstruation, the subject of menstrual pain experiences with both types of dysmenorrhea, PMDD, and PMS has been surprisingly absent. Urteaga et al. [
25] have approached primary dysmenorrhea and endometriosis, from the perspective of user engagement with a self-tracking smartphone application. A few valuable studies focused on menstruation-related conditions that do include pain experiences, such as Polycystic Ovary Syndrome (PCOS) [
18] and endometriosis [
65,
79]. However, these works do not centre the lived experience of pain and discomfort per se, but rather focus on the topic of contextual self-tracking of biodata, data aggregation, and collaborative sensemaking.
In this paper, we address this research gap by examining existing menstrual pain care technologies. We draw on Feminist Disability Studies as a lens to critically reflect and imagine designing for and with this disruptive experience otherwise. We take a critical, non-normative stance, and reframe this pain as an ongoing, and fluctuating lived experience that goes beyond narratives of concealment and individualisation.
3 Understanding Menstrual Pain Through the Feminist Disability Studies Lens: Three Pillars
Feminist Disability Studies (FDS) is a body of critical and cultural work that questions the naturalised and essentialised conception of disability. In [
40], Rosemarie Garland-Thomson defines disability as
a vector of socially constructed identity and a form of embodiment that interacts with both the material and the social environments (p.1559). Such framing questions the popular, medical perspective of disability as a physiological problem –often accompanied by cultural narratives of tragedy, misfortune, flaws, inferiority, and overcoming – in need of medical interventions and assistive technologies. Various strands of FDS [
55,
66] interlace queer theories, cultural studies, and critical race theories to reach a holistic critical analysis of literary and cultural narratives of disability. Notably, works by Robert McRuer [
66], Alison Kafer [
55], and Sami Schalk [
95] illuminate the deep entanglement of disability with systems of gender, sexuality, race, and class. These works compellingly disclose the oppressive presumptions of power and able-bodymindedness, which Tobin Siebers refers to ‘ideology of ability’ [
100], and their discriminatory ramifications.
Based on critical understanding of disability, FDS strive for opportunities to rebuild the material-semiotic world to a more equitable and inclusive environment. In this scholarship, disability is interpreted as human variation [
40], difference [
99], and political identities [
40,
55]. Hamraie and Fritsch [
43], for instance, urged designers to take into account the lived experiences of disability and actively involve them in the activities of designing and building technology. They highlighted the potential of leveraging technoscience for political and solidarity actions, and resisting the demands to “cure, fix, or eliminate disability”. Over the past decade, HCI researchers have employed these approaches and proposed novel pathways for design practice by countering the curative and solutionist narratives, and centring the experiences of disability [
3,
10,
29,
49,
60,
107,
121].
Menstrual pain is situated in an intricate space. Multiple factors intersect in this space, such as biomedical and/or sociocultural definitions of menstrual pain, gendered prejudices, menstrual stigmas, and the discrepancy between medicalisation and medical dismissal of menstrual pain as a mere hysteria. We argue that FDS and crip approaches can provide an analytical lens to critically understand the existing menstrual pain care technologies, while accounting for this complexity of menstrual pain.
To develop this argument further, we start by first laying out key concepts that are frequently used in FDS and crip theories. These concepts will help us to rethink disabilities and bodily breakdowns, and especially that of pain, offering a “counterlogic to the overdetermined cultural mandates to comply with normal and beautiful at any cost” [
39]. The key concepts we draw on are: disability/pain as lived experience; crip time; and pain as a shareable and shared experience. In the following subsections, we encapsulate feminist crip thoughts and ideas around each concept into three respective theoretical pillars. We will unpack the ambivalent site where menstrual pain is situated in – as an abnormal pathology, but at other times as a normalised fatality of a menstruating (and reproductive) body. The three pillars will offer an analytical ground for interaction critique of existing menstrual pain technologies in Section 5. We draw heavily on the works of Cara E. Jones [
53] and Ela Przybylo and Breanne Fahs [
83] who expressed the absolute necessity and relevance of the FDS lens to understand menstrual pain and endometriosis.
3.1 Pillar One: Diagnostic, Pathological Understanding of Menstrual Pain
Medical understanding of menstrual pain has offered significant solutions for those experiencing extreme pain, such as NSAIDs, which are the most commonly used pharmacological treatment for primary dysmenorrhea [
50], and pain killers (e.g., acetaminophen). However, when designing interactive technology, the medical perspective could only provide a limited account of menstrual pain. Menstrual pain embodiments cannot be only accounted for as a diagnosed bodily disorder to be cured back to ”normal”, nor a tragic state that should be prevented at all costs. Such medical understanding fails to surface what is diagnosed as legitimate menstrual pain and what not, who makes these decisions, and how patriarchal, capitalist, ableist society has influenced the experience of menstrual pain [
88]. Our intent is not to undermine the role of biomedicine in alleviating pain nor to argue that pain should be endured [
77,
82], but rather to highlight that we need not
oversimplify complex cultural, historical, and political phenomena of pain [
77]. Turning out attention to the felt and lived experience of menstrual pain could open up a space to explore varying temporal states of bodyminds [
82] and understand pain as
an integral part of one’s embodiment, character, life, and way of relating to the world [
40].
Listening to and learning from the felt and lived experience of pain gains particular importance when we think about the wide range of menstrual pain. Menstrual pain is not limited to an erratic pain around the abdominal area. Common symptoms of menstrual pain affect the entire bodymind: pain on the back/thighs, joint or muscle pain, nausea, vomiting, constipation, diarrhoea, fatigue, insomnia, bloating, breast tenderness, enmeshed with psychological symptoms such as PMS, PMDD, depression, anxiety, anger, and irritability. The dominant symptoms of menstrual pain or PMS are also known to be experienced differently among individuals and across one’s lifespan [
22,
80]. Thus, upholding the access of care only to medically diagnosable type of menstrual pain would, in turn, oblige sufferers to fit their experience into this type to come back to a ‘normal, healthy state’ [
70]. The variety, variance, and vague definition of menstrual pain get interlaced with gendered norms and abjection on women and menstruating bodies to generate negative metaphors of malingering, catastrophising [
61], infertile [
53], and disabling [
118]. These metaphors further silence the voices of pained bodies and isolate them through stigmatisation and circumscribing the capacity of language for pain communication [
40].
To critically articulate plural materiality of pain experience in juxtaposition with sociocultural factors that shape how people
feel menstrual pain (and which pain are “allowed” to be felt), we take cues from Alyson Patsavas’s cripistemology [
77] and Cara E. Jones’ “pain-centric approach” [
53]. Both scholars urge to value knowledge produced about/through pain, which have been relegated to medical knowledge, especially in the case of feminised chronic pain (i.e., menstrual pain and endometriosis). Patsavas [
77] suggests an alternative epistemology of pain and disability, namely cripistemology. Cripistemology is "a process of knowledge production that situates pain within discursive systems of power and privilege" [
77]. Through autobiographical journaling on living with chronic pain, Patsavas demonstrates how queer/crip readings of pain could restore personal yet political sense-making of pain. Such an approach will be relevant to unpick diverse material experiences of menstrual pain, as a comprehensive phenomenological experience of the self that unfold in different life-worlds and temporalities, influenced by gendered and able-bodied assumptions. Similarly, Jones [
53] proposes a “pain-centric approach” to better understand endometriosis and menstrual pain, taking a more comprehensive attitude. The Pain-centric approach
utilises the insights of medical, social-constructionist, and political/relational models of disability. Through such lens, we could centralise lived experiences of pain and extrapolate how this experience intersects with gender, race, class, and sexuality. Especially, Jones acknowledges the fundamental inter-shaping between medical and social factors, calling for the simultaneous betterment of both medical interventions and social settlements for structural support and liberation from stigmatising metaphors.
3.2 Pillar Two: Menstrual Pain Positioned in Normative and Curative Time
Disability, illness, and pain are always understood in terms of temporality -
frequency, incidence, occurrence [
55]. We are used to categorising them through temporal notions such as congenital, acquired, accidental, episodic, acute, and chronic, diagnosis and prognosis, and remission and relapse. As abundant as these notions are, people with disability and pain experience “reorientation of time”, namely a crip time. However, seldom do we discuss and construct worlds with crip time. Instead, time is understood as linear and progressive, a unit to compare productivity within the social spaces presuming able-bodyminds. When evaluated from this normative time, the lives of people with disability or pain could exist only under the frame of “curative time”. Disabled and pained bodies are cast as ‘out of joint’ [
34]. Under this curative time, time is either
cured time, of which the impairment has been eliminated, or time spent heading
towards the cured state.
The logic of normative and curative time is also inherent in the general sentiment of problematising menstrual pain. For instance, some clinical studies have reported on the detrimental impact of menstrual pain on productivity. In [
50], dysmenorrhea pain is reported to be the primary cause of short-term school and work absenteeism among young women. It is estimated that up to 30 percent of all working or studying women with dysmenorrhea lose 1-2 working days per month, culminating in an annual loss of up to 600 million working hours only in the USA [
108]. Also, Nnoaham et al. [
73] present that people with endometriosis lose, on average, 10.8 hours of work per week. These statistical results support that menstrual pain indeed widely affect people’s everyday lives. However, their calculations unknowingly take the non-menstrual, non-endo(metrial) bodies, presumably abled and mostly male bodies, as default embodiments of comparison. Under this skewed standard, the time of menstruating and pained bodies becomes un(re)productive time that lags behind the normative time. Taking medical treatments becomes not only desirable but an imperative to reach the curative time, and to eventually keep up with the required speed of normative time.
Meanwhile, crip time offers a reorientation to a time, corresponding to the belief that “time ‘is’ a body” [
35, p.14]. Alison Kafer, a feminist disability studies scholar, describes that crip time
“requires reimagining our notions of what can and should happen in time, or recognising how expectations of ‘how long things take’ are based on very particular minds and bodies” [
55]. Like this, Kafer foregrounds that time is experienced in, on, and across the bodyminds. To account for crip time is more than just securing extra time for people with disability and pain, but about
bending the clock to meet their particular bodyminds. Menstrual pain is not necessarily a disability. Yet, it as a gendered, long-term psychosomatic disruption, the concept of crip time could afford a generative way of understanding time situated in menstrual pain embodiments.
Building on this, Przybylo and Fahs set forth enfleshed and material temporality of menstrual pain and contend it to be understood as
a crip temporal embodiment [
83]. In [
83], they interweave Elizabeth Freeman’s concept of
chronicity with their duo-autobiographical stories of living with menstrual pain, and put forth “cyclic chronicity” as a method to probe menstrual pain temporality. As opposed to
straightforward time, cyclic chronicity entailed in menstrual pain experiences spurs queering of the relation to time,
not as forward, or backward-moving, but as ebbing and flowing in varying degrees of intensity and insistence, compression, and dilation [
36, p.339]. This reconceptualisation of time liberates people from numerous misinterpretations of menstrual pain time: as a developmental passage, soon to be passed through; as a redemptive time to be endured for the better good of reproduction; or as a lost resource of time that could have been put into production. Menstrual pain is expected and unexpected, stagnant and abrupt, untimely, and a time of relief or retrospection. Oftentimes, it means rescheduling tasks, (un)intentionally living slow or fast or using time loosely. In fact, menstrual pain time is experienced differently throughout one’s menstrual cycles – when anticipating, during, or after menstruation – or throughout irregular or anovulatory cycles – time experienced suspecting, denying, or realising menstrual pain or encountering unexpected pain. And various factors influence each individual’s menstrual pain time, such as their vocation, socioeconomic status, illness or disability, race, use or un-use of other adjacent technology (e.g., menstrual tracker). With this material temporality of menstrual pain in mind, pain can
grow, pulse, stay with us, and return [
83].
3.3 Pillar Three: Individualised, thus Invisible Bodies in Menstrual Pain
The ways in which pain is experienced and perceived are culturally and socially informed. It is important to acknowledge this because these sociocultural factors actively construct what pain looks like and which pain should be done away with. The long history of menstrual negativity and shame is undeniable. In many cultures and geographical locations, menstruation has been (or still is) associated with abjection [
56], dirt [
78], waste (often in relation to a “failed” reproductive cycle) [
62,
78], madness, impurity, aberration, and contagion [
83]. Theese metaphors around menstruation create the imperative of menstrual concealment [
122], which is internalised among women and menstruators. Drawing on Erving Goffman’s concept of
passing [
41], Sharra Louise Vostral illuminates how menstrual hygiene technologies reinforce the ideals of hiding menstrual embodiments and passing as non-menstruators [
117]. Vostral expands how these sentiments are also dispersed in the context of menstrual pain. As non-menstruating bodies are presented as normal bodyminds, people are implicitly encouraged to perform “normal” by containing menstrual pain and masking distress. Menstrual pain becomes more of an unspeakable experience in a vicious cycle of ableism – where social scripts portray pained (and menstruating) bodies as abnormal and unable to function, nudging them to disguise themselves which, in turn, reinforces the abnormalisation of bodies in menstrual pain [
119].
Ironically, menstrual pain is normalised and individualised in other contexts. The essentialised understanding of menstruation takes a huge toll in normalising menstrual pain as a
“pain that must be endured, a pain that is unreal, a pain of individual growth or enrichment” [
83, p.209]. This conception of menstrual pain hinders people from getting timely access to medical, social, and political support, as exemplified by Jones that reducing it to mere “painful menses” contributes to delays of endometriosis diagnosis [
53]. Some feminist scholars [
54,
116] even held the terms, PMS and PMDD, accountable for naturalising depression and obfuscating the realness of somatic pain by lessening it to a psychological malingering. Normalisation of menstrual pain is also exacerbated by misogynic and racist assumptions around pain resistance and pain sensitivity. For instance, presumptions that women and people of colour are better at enduring pain and more prone to complaining and catastrophising pain compared to men, have led to dismissals of their pain reality [
96].
Normalised experiences of menstrual pain are quickly rendered into a personal tragedy, with accentuated responsibility of individuals to maintain their healthy bodies [
70]. With the proliferation of digital technologies and lifestyle industries, self-surveillance and self-governance have become an everyday practice for many. Feeling pain is perceived as to embody insufficiency, thus something that can be treated and overcome through new products [
40,
83]. Notably, Patsavas explains how many popular editorials cast chronic pain as an individual problem and accuse the over-regulation of pharmaceutical solutions as a key reason for the chronic pain sufferer’s tragedy. Like this, when pain is individualised, its cure through consumption becomes more accentuated, isolating the pained bodies into a consumer and obstructing the possibilities for them to build a sense of community [
46,
70,
77].
Patsavas [
77] and Przybylo and Fahs [
83] bring their attention to the inevitably relational nature of pain. Both scholars advocate for appropriating the notions of
leakiness and
contagion, which have been hitherto negatively associated with menstruation and menstrual pain, as a source of coalition and connectivity among people in pain. Patsavas [
77], for instance, narrates the autobiographical experience of accidentally sharing her own experience of chronic pain with a stranger and finding out that the person also suffers from chronic pain. This unexpected moment made her realise the possibility of a broader community. When her own pain had leaked and the boundary between pained and non-pained bodies was blurred, she could imagine pain beyond her own body. Patsavas also unpacks her experience of masking and occasionally sharing her pain with the partner to illustrate that pain experience is always relationally situated. Patsavas beautifully connects these autobiographical experiences related to pain with the concept of
leaky bodies by Margrit Shildrick as
discursive interplay between all bodies and all subjects [
98, p.217] and illuminates how a pain experience is inevitably leaky. Despite pain’s known disposition of depriving sufferers of any language [
93], people experience pain in relation to others and as well as sociocultural conditions. Referring to our own subjective experience of pain, we understand other’s pain with some overlap, and influence each other’s perception and experience of pain, even though it is impossible to fully grasp each other’s pain experience. Based on this idea of leakiness of pain, Patsavas urges to reconceptualise pained bodies and painful experiences within a “system[s] of connectivity” as something
shareable and as shared [
77, p.215], instead of an individual tragic event. Similarly, Przybylo and Fahs have repurposed so-far negative metaphor of
contagion to evoke a new sense of transmissible connectivity and coalition among menstruating bodies in pain [
83].
4 Method: Interaction Criticism
4.1 Overview of the Method: Interaction Criticism
Interaction criticism [
8] is a rigorous HCI practice of interpretative analysis that critically examines the aesthetics of the interaction. Inspired by the common epistemological practice of criticism in arts and humanities, interaction criticism emerged as an essential tool to produce knowledge through holistic and non-reductive readings of interaction designs. According to Bardzell [
7], interaction criticism aims to interrogate complex relationships between
(a) the interface (e.g., its material and perceptual qualities, its situatedness in visual languages and culture) and (b) the user experience (e.g., meanings, behaviours, perceptions, affects, insights, and social sensibilities). Interaction criticism is an apt method that complements pragmatic and representationalist approaches in HCI research, since it can illuminate discursive knowledge that are not easily revealed from the analysis of empirical data sets (e.g., interviews, surveys, or usability tests) [
7]. The methodological merits of interaction criticism in the HCI field have been demonstrated by numerous works. Previous works have used this method to establish a critical and generative grounding for design processes [
17,
27,
42], to develop new interaction design theories [
11,
59] and pedagogical methods [
27]. For instance, Gray et al. [
42] have applied interaction criticism to conduct value-sensitive analysis of web consent banners for data privacy and identified a design space for transdisciplinary collaboration. In [
45], Helms has critiqued commercial products for urination management to unpack societal perspectives on excretion management and speculate alternative design spaces.
We selected this method due to its strength in bridging philosophical ideas and critical theory into a practical form of doing design with technologies, thus encouraging
design-after-design [
27]. The method enabled us to actively engage with theoretical notions discussed in FDS on femininity, menstruation, and pain in a material and aesthetic level. In this work, we employed interaction criticism both as (1) a theoretically informed analytical method to unpack assumptions and narratives embedded in the aesthetic experiences of existing menstrual pain care products and technologies; and as (2) a generative method to yield designerly knowledge that may help us to reconfigure the design space that positions menstrual pain otherwise.
4.2 Our Approach to Conducting the Interaction Criticism
We conducted interaction criticism of three menstrual pain care products:
Myoovi (TENS-based) [
72] (see Fig.
3);
Maia (heat-based) [
74] (see Fig.
4); and
Moonai (app-based) [
71] (see Fig.
5). We chose products that explicitly target menstrual pain, and that involve a range of non-pharmaceutical interactive technologies. We included products utilizing TENS technology and heat due to their effectiveness in menstrual pain alleviation supported by numerous medical studies [
1,
4,
24,
52,
81]. An app-based product, Moonai was included due to its novelty and recency (launched in 2022) and its clear focus on menstrual pain care. By including Moonai, we sought to respond to Trépanier et al. [
113]’s call for further research on smartphone apps for menstrual pain. Focusing on these three different technologies allowed us to conduct an interpretative analysis with a generative diversity of modalities (i.e., electrical impulses, a dual modality of heat and mechanical touch, sound and visual graphics), variety of application (i.e., direct skin adhesion, body-worn, and smartphone app), and use duration (i.e., several minutes to hours).
Myoovi, Maia, and Moonai also offered us a good variety of features, wearability, context of use, and branding narratives. For instance, Myoovi’s aesthetic experience was generative for the critique as a wireless TENS-based device with different patterns and intensities of electric current stimulation. Its butterfly-shaped form in sleek, smooth textured material also well encapsulates the general trend of TENS-based devices for menstrual pain marketed as lifestyle products, shunning away from its clinical origin (see Fig.
1). For heat technology, Maia made an interesting candidate. Its design well represented other heat-based products, as a waist-worn, belt-shaped device intended to fit a user’s abdomen or back (see Fig.
2) with feminine visual branding. Also, its dual modality of heat and mechanical massage unit in varying intensities was a good addition to the critique. Lastly, we included Moonai considering its novelty, audiovisual modality, diverse possible context of use, and a personalisation feature. It was one of the very few apps that explicitly focus on menstrual pain management, which strongly resonates with Trépanier et al. [
113]’s finding that only 10 % of menstruation-related apps had pain management interventions. Thus, critiquing these three products enabled us to understand overarching menstrual pain care technologies from diverse perspectives.
In our critique, we followed the four perspectives of interaction criticism introduced in Bardzell’s framework [
7]: designer (creator), interface/product (artefact), user (consumer), and social context. Borrowing notions from art, literary, and critical theory to operationalise Manovich’s concept of
Transcoding, Bardzell proposes that these four perspectives appear in the mutual interaction of cultural and computer layers. To critically interpret each perspective, we considered the following materials. The materials listed here are not exhaustive –for example, when a product did not have any user reviews (like the case of Moonai), the first author downloaded the app to try it out.
•
Designer/Company (Creator): Product website; product’s social media account – posts (images, videos, and descriptions) excluding comments. Based on these materials, we interpreted the creator’s intention, and the dominant rhetoric used by the designer/company.
•
Product (Artifact): Product images or demo videos on the internet; researchers’ first-person experience. Based on these materials, we interpreted the product’s visual forms and language, material textures and attributes, and visual metaphors.
•
User (Consumer): Product website; user reviews on the product website; user reviews on social media channels (e.g., TikTok and Youtube); trial of a demo version. Based on these materials, we interpreted the anticipated user and user experience.
3 •
Social Context: Product website; product’s social media account - posts (images, videos, and descriptions) excluding comments. Based on these materials, we interpreted the social ideal each product constructs and in which social and political settings the product thrives.
Following the above four perspectives, the research team collectively analyzed each product during a critique session. The first author facilitated the session by bringing in the three theoretical pillars of FDS (introduced in Section 3) into the critique. We incorporated the pillars into the critical readings of the assumptions and narratives produced/mediated by/towards the creator/company, the product/interface, the user, and the social context of each market exemplar. Similar to Reime et al. [
87]’s approach, part of the team had first-person experience with these technologies which strengthened the critique.
4.3 Researcher Positionality
Using the interaction criticism method, we made informed judgments of the materials based on the three theoretical pillars. Since each researcher’s judgments were situated on their values and life trajectories, we allocate some space here to reflect on our positionality.
Our team is composed of researchers who identify themselves as women. All researchers have or had varying degrees of menstruating and menstrual pain experiences. Through discussions, we learned that we share different lived experiences of menstrual pain, which may have been related to each individual’s (reproductive) health conditions, menstrual cycles, contraception methods, or age. For example, our research team includes people with the experience of living with PCOS. This diversity of experience encouraged us to incorporate diverse embodiments of menstrual pain.
The team includes researchers currently working in the context of menstrual and reproductive health technologies, accessibility, and feminist HCI. Having such research orientations, the researchers share critical perspectives on normative gender dichotomy, structural inequalities, and social justice. Additionally, our team is composed of individuals with diverse socio-economic and cultural backgrounds, from East Asia, Latin America, Europe, and North America. Each researcher grew up in a different social and cultural background which shaped the understanding of our own menstruating body and embodiment of menstrual pain. This research was conducted in Sweden, where none of us were born nor raised.
6 Discussion: Feminist Crip Provocations for Menstrual Pain Technologies
In this section, we consolidate and reflect on our interaction critique results to pinpoint the gap space for new design possibilities. We propose three design provocations, one per pillar, imagining feminist crip ways of designing menstrual pain technology. We will highlight experiential qualities of technology that foreground menstrual pain as diverse lived experiences, cyclical and chronic crip time, and as a shareable and shared experience with contagious coalitional potentials. We illuminate new possibilities and tensions embedded in each provocation by relating back to FDS literature and previous works in HCI that take a similar approach. By doing so, we call for fellow designers/researchers to engage with this radically new design space for menstrual pain.
6.1 Menstrual Pain as Lived, Plural Experience
We found it promising that all three products acknowledge the realness of menstrual pain, and reject its normalisation as gendered malingering. The products also indirectly motivate users to notice pain sensations more, in a sense that users would have to gauge whether to use them or not. Yet, the interactive experiences of all three products were underpinned by the medical and pathological understandings of menstrual pain. These products perceive menstrual pain as a congregate list of problematic symptoms. wrapped in the aesthetic and rhetoric of natural, organic, and non-invasive pain-killing. With their lifestyle or cosmetics, and purposefully non-medicalised appearances, the products promise to suppress, numb, and annihilate users’ pain instantly based on the medical conception of pain, leaving not enough space for cripistemology to develop. Immersed in physiological (bodily discomfort caused by prostaglandins) or psychosomatic (neurological response to pain signals) conceptions of menstrual pain, these products fail to address menstrual pain experienced differently across bodies as sociocultural configurations, and through one’s lifetime. And such understandings shape which pain is to be felt, recognised, and tracked.
6.1.1 Provocation One: Cultivating Somatically Situated Knowledge through Pain Sense-making.
As prevalent as menstrual pain is, people’s experiences of and relationship with it are diverse, ever-changing, and fluid. From this vantage point, we provoke what technologies can facilitate users to construct their own
cripistemology [
77] and support them not only to discern their own felt experience of pain but also contextualise it within the systematic power and privilege relations. Within HCI, Demir et al. [
21]’s work has exemplified how the lived experience of chronic pain can be materialised into tangible artefacts. Using soma design, the artefact they made has demonstrated the potential for collaborative sense-making and sharing of chronic pain experiences. Similarly, Fyhn and Buur [
37] and Beuthel et al. [
12] showed tangible materials’ capability of spurring new perspectives in sharing and articulation of pain embodiments – without being held back by the scarcity of language [
93] or stereotypical metaphors – which could lead to better understanding one’s own soma. There are, of course, tensions around whether touch-based first-person pain experiences can be accurately conveyed to other people with different body shapes and pain sensitivities. Nevertheless, we can take cues from these works to envision whether and how tangible materials can spur more political and pain-centred menstrual pain sense-making, resisting the universal and objective representations of menstrual pain.
Furthermore, we might wonder whether there may be some leverage in building on approaches that advocate for a proactive engagement with pain. For example, scientific evidence already shows that specific stretching and Kegel exercises can reduce symptoms of menstrual pain [
75] attributed to an increase in local blood supply. Within HCI, sonification of movement has been used with people with chronic pain to investigate how a device that senses movement, and gives sonic feedback to movement might improve functional activities in the home. Singh et al. [
101] found that technology could both enable functional activity, and provide a tool for developing a personalised pain management strategy. They propose a strategy that is not to avoid movement (and, therefore, pain, altogether), but to set limits for the maximum amount of movement and therefore, pain that should be experienced. Taking inspiration from this, we could imagine future menstrual pain technologies which encourage users’ movement and stretching as part of pain management strategies. It might be also interesting to speculate on how the boundaries of pain management set by such interactions might help individuals to affirmatively live with (chronic) menstrual pain and assess for themselves when pain has reached levels that require a different intervention.
6.2 Menstrual Pain and its Cyclical, Chronic, Crip Time
Menstrual pain engages with a kind of time that challenges the normative temporalities that govern our neoliberal-capitalist societies. Being in menstrual pain recurrently throws into sharp relief the productive impulses that animate our places of work and dwellings. For example, Moonai’s interactive experience holds potential to resist these impulses by affording users to embark on private, ritualistic menstrual pain time, taking a break from normative productive time. However, the other two products we critiqued revealed the void space of designing for menstrual pain time. They were designed and suggested to be used to keep up with a progressive, forward time, while the cyclic chronicity and fluctuation of menstrual pain were neglected or cast as something to be resolved. In particular, oppressive gendered norms on women’s ideal body shape came into play, as exemplified in the case of Maia, compelling the users to self-discipline to block or overcome appearance-related bodily fluctuations such as bloatedness, weight gain, and embarrassment.
6.2.1 Provocation Two: Bending Time towards the Crip Time of Menstrual Pain.
Building on the works related to time-keeping and alternative temporalities [
29,
91,
97] we could first suggest a centring of pain time, that is to prioritise caring for the body (or other bodies). This is much in line with the recent speculations by Yadav et al. [
123]. They proposed enabling individuals to schedule breast pumping in ways that might allow them to make their caring practices more visible as they desire. But we might also acknowledge that there are tensions in this. Much like the participants in [
123] sometimes it is not possible to take a break or to go slower, either because of the demands of work, or because of one’s own goals and needs.
In relation to this, Emma Sheppard [
97] introduces the idea of
pacing, an activity of intentionally scheduling rest and low-activity periods. Pacing can be both a rehabilitative normalising practice and a practice of self-care. And, so we could ask, what might be interaction design’s role in helping people navigate time in ways which can be understood as conforming or read as troubling time. In [
29], Forlano delineates how the researcher’s data rituals - data logging, tracking, measurement, transmission, and repairing of Type 1 diabetes monitoring machine - shift throughout time. The data rituals cross over normative clock time and the crip time of slowing down, speeding up, liminal time, and sharing time. This can provide a generative starting point for speculating how technologies could attend to menstrual pain rituals by supporting users to switch between normative time and crip time, which comes back chronically and recurrently. One possible way of visually hinting such temporal bridge between normative and crip time can be found in Kathleen McDermott’s ‘Urban Armour’ [
63]. Urban Armour is a collection of wearable pieces that enable an individual to, for example, protect one’s personal space through an expanding skirt –a skirt that absolutely looks like a skirt yet which the wearer knows will change its shape to demand extra space when required. In such a way, the artefacts can be designed to offer semi-ambiguous visibility, while also feasibly camouflaging the particulars of the pain experience from those who cannot know.
6.3 From Individual Problem Towards Shareable and Shared Experience
However prevalent menstrual pain is, existing menstrual pain technologies frame it as an individual well-being or lifestyle issue. In our critique, we presented how the three products decontextualise and depoliticise menstrual pain, uprooting it from the interpersonal, social, and cultural relations in which it is situated. When menstrual pain is detached from those relations, menstrual pain care becomes a matter of a personal choice, weakening the imperative for social welfare and equitable access. All three products, their user experiences, and marketing materials rarely positioned menstrual pain as a communal experience that goes beyond heteronormative and gendered norms on menstruation. Individual responsibility of self-care through usage of commercial products was accentuated with the promise of passing as non-menstruators. While the products’ social media posts have introduced content on menstrual pain awareness or menstrual positivity, they do not reflect deeper into the systematic structures that implicitly coerce their users to pass as non-menstruators. The posts talked about how terrible having a menstrual leakage or going through a flare up was, but didn’t question who or what about it makes them feel this way. Also, the products’ discreet wearability and intimate modality contribute to the concealment of menstrual pain, rendering it materially and socially invisible and unshareable.
6.3.1 Provocation Three: Creating Leaky, Contagious Coalition.
Przybylo and Fahs [
83] ask us to pay attention to the dual reality of menstruation: containment and contagion. They suggest that the experience of menstruation can be a place of resisting containment through inter-connected contagion. Like menstrual solidarity, we can take into account the collective and relational experiences of menstrual distress and pain through a FDS lens [
40,
53,
100,
120]. This leads us to imagine spectacular [
92] wearable technologies that enable pain management strategies (e.g., aesthetically ready-to-wear wearable touch devices for different parts of the menstruating body) that both seek to alleviate pain while also making abundantly clear to those around you that you are in pain. We might also imagine futures where places of work and education that contain places for public rest.
In her exhibition WELL BEINGS [
38], the artist Valentina Karga invites visitors to consider the tensions that arise in being together, sharing feelings of anxiety and discomfort. Karga’s work creates an experience where the audience is exposed to continually streaming media that conveys the severity of the climate crisis, while also offered marketed products for resolving the anxieties that she might feel, such as soft, heatable objects and weighted blankets. This juxtaposition of the two is striking, that rather than seeking to solve the crisis, we seek personal comfort instead. However, we find this collective navigation of a painful experience something promising to explore in relation to menstrual pain experiences. In showing one another that we are in crisis or leaking our pain, are we more able to create coalitions with others who are feeling similarly? From this stance, we imagine designing interactive technologies for menstrual pain that can be used as ways of sparking solidarities within one another. Homewood’s work on Ambient Cycles [
47] is perhaps one example that might serve as inspiration here - a design that ‘infects’ a home space with a continual and ambient reminder of one’s menstrual cycle status. By mobilising leaky contagion of menstrual pain, we can imagine technologies - wearable or otherwise - that ignite knowing glances amongst people as they wordlessly feel and understand one another’s experiences. In this way, we can imagine menstrual pain technologies that evoke
access intimacy [
68], an elusive and communal feeling when someone gets your access needs without needing to request it, among asynchronously existing pained community of women, menstruators, and non-menstruators.
6.4 Limitations and Future Works
Due to the interpretative nature of our work, and since criticism is situated in our own positionality, the results of the interaction criticism and provocations are not intended to be definitive or authoritative [
7]. Rather, our critique and provocations are situated in our feminist orientations and lived experience of menstrual pain. Thus, we view them as an invitation for other researchers and practitioners to further explore and leverage when they design care technologies. Also, our analysis does not offer a systematic overview of the multiplicity of menstrual pain technologies, nor associated user experiences. Further empirical research would be needed to address such goals. Lastly, since the critique focuses on the interactive experiences and narratives, our analysis does not focus on the privacy and security aspects of these commercial products. Future work could bring in ethical and legal frameworks to critically unpack the experience of user privacy and data security of these technologies.
7 Conclusion
Menstrual pain is a widely experienced, gendered, chronic bodily disruption. Within popular discourse, it has been overlooked as trivial “female trouble” [
90]. Feminist scholars have also been careful about discussing the pain of menstruation with the intention to act against the pathologisation of menstruating bodies [
53]. Acknowledging the distinctive temporal, political, and cultural background of menstrual pain, we drew on feminist disability studies perspectives on pain and critically analysed the predominant norms and narratives constructed around menstrual pain.
Our interaction critique of three commercial menstrual pain technologies unveiled that while these technologies acknowledge the realness of menstrual pain, they still frame menstrual pain as an individual problem to be solved. By bringing feminist disability studies into conversation with menstrual pain and interaction design, we provoke new design possibilities for menstrual pain technologies. Our provocations highlight opportunities to resist the universal and objective representations of menstrual pain, and bring in designs for living with the ebbs and flows and creating contagious solidarity among people in menstrual pain.
